HomeMy WebLinkAboutAPPLICATION, BP - 06-00411 - 85 Oak Ave - FireplaceZ
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CITY OF KEXB UAG
BUILDING PERMIT APPLICATION
19 E MAIN, REXBURG, ID. 83440
208-359-3020 X326
Plea 06 00411 n~
If the ~ g 5 Oak Ave-Mechanical ale
PARCEL NUMBER: ~P I~~P~~~6~ 1 ~'l~ ~ we wail provide this for you)
SUBDIVISION: UNIT# BLOCK# LOT#
(Addressing is based on the information -must be accurate)
CONTACT PHONE # , 7. ~ ~ "
PROPERTY ADDRESS: ~ ~ 6D/~~,~~j/~ ~~' - y/~v2
PHONE #: Home ( ) ~ Work
Cell
OWNER MAILING ADDRESS: l~l~l2~-- CITY: STATE: ZIP:
EMAIL F.
_-
APPLICANT (If other than owner)
(Applicant if other than owner, a statement authorizing applicant to act as agent fox owner must accompany this application.)
APPLICANT INFORMATION: ADDRESS CITY:
STATE; ZIP EMAIL FAX
PHONE #: Home ( ) Work ( ) Cell ( )
CONTRACTOR:
MAILING ADDRESS: ~`~ ~ 2oY~ /~~ CITY Misr-~~~''c STATE~ZIP~
PHONE #: Home ( ) ~ ~~ ' ,~~`J~Work ( ) ~~'~-~ ~//~U Cell ( )~ /;7 "~ ~~~~
EMAIL FAX IDAHO REGISTRA
How many buildings are located on this property? ~'
Did you recently purchase this proper No Yes (If yes give owner's
Is this a lot split? NO YES (Please bring copy of new legal
PROPOSED USE:
(i.e., Single Family Residence, Multi Family, Apartments, Remodel, Garage,
2~ # & EXP: D A~~
~.. ' .1 ~
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of property)
,dditioxl> ~.T&~) i ~ `.... .
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APPLICANT'S SIGNATURE, CERTIFICATION AND AUTHORIZATION: Under penalty of perjury, I hereby certify
that I have read this application and state that the information herein is correct and I swear that any information which may hereafter be given by me in
hearings before the Planning and Zoning Commission or the City Council for the City of Rexburg shall be truthful and correct. I agree to comply with all
City regulations and State laws relating to the subject matter of this application and hereby authorized representatives of the City to enter upon the above-
mentioned grope for inspections purposes. NOTE: The building official may revoke a permit on approval issued under the provisions of the 2003
Internation Co in cases of any alse statement or misre resentation of fact in the application or on the plans on which the permit or approval was
based. Pe 't id if not st 'thin 180 days. P 'void if work stops fo 180 days. ~
Signatur of O er/Applicant DATE
Do you prefer to be contacted by fax, email or phone? Circle One
WARNING -BUILDING PERMIT MUST BE POSTED ON CONSTRUCTION SITE!
Plan fees are non-refundable and are paid in full at the time of application beginning,lanuaryl, 2005.
City of Rexburg's Acceptance of the plan review fee does not constitute plan approval
**Building Permit Fees are due at time of application's '~*Building Permits are void if your check does not clear**
2
Please COmPlete the entlre AppllCatl.On~ If the question does not apply fill in NA for non
applicable
NAME
PROPERTY ADDRESS
SUBDIVISION
Permit#
Required.!!
MECHANICAL
Mechanical Contractor's Name: Business Name:
Address City State Zip
Contact Phone: ( ) Business Phone: ( )
Email Fax
Mechanical Estimate $ (Commercial/Multi Family Only)
FIXTURES & APPLIANCES COUNT (Single Family Dwelling Only)
Furnace Exhaust or Vent Ducts
Furnace/Air Conditioner Combo Dryer Vents
Heat Pump Range Hood Vents
Air Conditioner Cook Stove Vents
Evaporative Cooler Bath Fan Vents
Unit Heater other similar vents & ducts:
Space Heater
Decorative gas-fired appliance
Incinerator System
Boiler
Pool Heater
-~ Fuel Gas Pipe Outlets including stubbed in or future outlets
Inlet Pressure (Meter Supply) PSI
Heat (Circle all that app Gas Oil Coal Fireplace Electric Hydronic
Mechanical Sizing Calculations must be submitted with Plans & Application
Point of Delivery must be shown on plans.
Si ature of Licensed ntractor License number -~ Date
The City of Kexburg'.r permit fee schedule is the .came as required by the State o{Idaho